Aphasia 93Predominantly Expressive Aphasia
Patients with predominantly expressive aphasia have difficulty encoding (formulating) lan-
guage to express themselves. The core language deficits in this form of aphasia are difficulty
recalling names and prob lems in constructing sentences and phrases. There are several types
of naming prob lems in aphasia. Some patients are unable to supply any word for a concept
or object. For example, when asked to name objects, they are silent or try to have the listener
supply the words. Other patients produce the wrong word and may or may not be aware of the
mistake. They may say an incorrect word that is associated with the correct one, such as pen for
pencil, knife for fork, or car for truck. These association errors are also called verbal paraphasias.
Sometimes patients may say words that phonemically approximate or rhyme with the correct
word— fan for tan, pen for hen, or bun for run. These approximation errors are also known as
literal paraphasias. In random naming errors, there are no semantic or phonological associa-
tions—no rhyme or reason to the word- finding or naming errors. A patient making a random
naming error might call a car a banana.
As noted earlier, predominantly expressive aphasia usually has a motor component. In some
instances, the patient can recall the word he or she wants to express but has difficulty program-
ming and sequencing the speech muscles to produce it. The motor aspect of predominantly
expressive aphasia involves purposeful speech acts. Usually, there is a volitional- involitional
dichotomy in programming speech. The patient may be unable to program and sequence the
speech muscles for purposeful and voluntary movements but can speak some words automati-
cally and involuntarily.
When aware of the naming error, the patient will often attempt to correct it and may or may
not be successful. These attempts to self- correct often render speech nonf luent, with hesitations,
repetitions, and revisions. Some patients use tip- of- the- tongue be hav iors, in which production of
the word is just out of reach and the patient makes repetitive attempts to say it. Because of their
reduced vocabulary and impaired grammar, many patients employ telegraphic speech, using con-
tent words to the exclusion of grammatical and functional ones. For example, “I bathroom” is a
telegraphed utterance indicating that the patient wants to go to the bathroom now.
Predominantly Receptive Aphasia
Patients with predominantly receptive aphasia have prob lems understanding the writing, ges-
tures, and speech of others. They have varying degrees of difficulty decoding (analyzing) language.
These prob lems can occur at the perception (see the following section, Aphasia and Agnosia) or
association levels and are more apparent when the amount of information is increased. Attention
deficits may also be pres ent and may contribute to the decoding impairments. Some patients have
slow rise time, attending to only the last part of a statement or request. In the opposite reaction,
auditory fade, the patient attends to only the first part. Although conventional definitions of apha-
sia state the receptive disturbances occur because of damage to Wernicke’s area, receptive language
involves the brain functioning as a whole, and Wernicke’s area is only a conduit to understanding
the speech, writing, and gestures of others.
Speech in predominantly receptive aphasia is usually f luent unless the patient stops to improve
self- monitoring. Typically, these patients do not use f luency disruptions such as hesitations, repeti-
tions, and revisions. Many of them also use jargon speech, broadly defined as f luent but mean-
ingless utterances, although some aphasia classification systems limit the definition to specific
types of utterances. In general, jargon speech can be disrupted by semantic or phonemic factors.
Conventional words may be used in such a way that the sentence has no meaning, such as, “It
depends on the acrylic, thus far.” Jargon speech may also consist of neologisms (in ven ted words)
such as kryptocat or tula. Many patients with jargon aphasia produce a combination of made-up
words and conventional ones used incorrectly.